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心房调转术(马斯塔德手术)治疗大动脉转位患者的右心室功能(作者译)

[Right ventricular function in patients with transposition of the great arteries after atrial inversion (Mustard procedure) (author's transl)].

作者信息

Luhmer I, Weber L, Wuttke S, Oelert H, Kallfelz H C

出版信息

Herz. 1981 Dec;6(6):352-5.

PMID:7319448
Abstract

Twenty-nine patients with transposition of the great arteries (TGA) and intact ventricular septum underwent hemodynamic and angiocardiographic investigation 18,8 +/- 5,8 months after inflow correction (Mustard). The mean age at operation was 14,6 +/- 7,5 months and in all, a good anatomical result was achieved. The hemodynamic parameters such as cardiac index, pressures in all heart chambers as well as in the venous channels and arterial vessels were found within normal limits. The end-diastolic volume of the right ventricle (RVEDV) was closely correlated to body surface area (r = 0,697). It increased, however, more rapidly than in children with normal hearts. Mean RVEDV/m2 was 86 +/- 8 ml which is 123 +/- 10% of the normal values for children (70 +/- 13 ml) according to Graham et al. The mean ejection fraction (EF) of the right ventricle (58 +/- 7%) was only slightly below the normal range (65 +/- 7%). Thus, a good hemodynamic function of the RV can be assumed at least for the early postoperative years after a Mustard operation. It remains open, however, if the more rapid increase of RVEDV/m2 expresses the RV adjustment to the afterload of the systemic circulation or if this should be interpreted as an early sign of RV functional impairment.

摘要

29例大动脉转位(TGA)且室间隔完整的患者在进行流入道纠治术(Mustard术)后18.8±5.8个月接受了血流动力学和心血管造影检查。手术时的平均年龄为14.6±7.5个月,总体上取得了良好的解剖学效果。发现心脏指数、所有心腔以及静脉通道和动脉血管内的压力等血流动力学参数均在正常范围内。右心室舒张末期容积(RVEDV)与体表面积密切相关(r = 0.697)。然而,它的增加速度比正常心脏的儿童更快。平均RVEDV/m²为86±8 ml,根据格雷厄姆等人的数据,这是儿童正常值(70±13 ml)的123±10%。右心室的平均射血分数(EF)(58±7%)仅略低于正常范围(65±7%)。因此,至少在Mustard手术后的术后早期,可以认为右心室具有良好的血流动力学功能。然而,RVEDV/m²的更快增加是表示右心室对体循环后负荷的适应,还是应将其解释为右心室功能受损的早期迹象,这一点尚不清楚。

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